Summary Report for FSPSAs Ending During the Report Period Center: 57
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3371 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
TCM -T1017TL TARGETED CASE MANAGEMENT 173 174 104.071433 $3850.6600 $37.0000
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Subtotal (Total Children Is Unduplicated) 173 174 104.071433 $3850.6600 $37.0000
Screening, Eval, and Assessment, Class # 02
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 8.063492 $411.6400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 83 86 42.446830 $2166.9300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.766667 $39.1400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 44 15.966668 $815.1100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.477778 $24.3900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 79 80 37.357149 $1907.1100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 10 4.677778 $208.4000 $44.5500
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Subtotal (Total Children Is Unduplicated) 144 231 109.756362 $5572.7200 $50.7700
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 2 0.711112 $35.5600 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 253 260 106.366668 $5318.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 41 19.827777 $991.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 461 479 209.230959 $10461.5900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 97 124 715.285701 $17882.2000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 795 833 4734.650771 $236732.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 813 851 4843.333309 $48433.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 111 137 438.642876 $31336.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 6.857143 $392.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 61 70 214.357153 $15313.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 13.857143 $792.0800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 132 158 571.285733 $40812.6100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 8.642858 $119.9600 $13.8800
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Subtotal (Total Children Is Unduplicated) 928 2966 11883.049203 $408622.0900 $34.3900
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Total 3371 12096.876998 $418045.4700 $34.5600
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Number of Children (Unduplicated) With at Least One Authorization 966